Provider Demographics
NPI:1730293432
Name:NORTH MOUNTAIN DERMATOLOGY LTD
Entity Type:Organization
Organization Name:NORTH MOUNTAIN DERMATOLOGY LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-944-4626
Mailing Address - Street 1:50 E DUNLAP AVE
Mailing Address - Street 2:#105
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-2877
Mailing Address - Country:US
Mailing Address - Phone:602-944-4626
Mailing Address - Fax:602-944-2805
Practice Address - Street 1:50 E DUNLAP AVE
Practice Address - Street 2:#105
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-2877
Practice Address - Country:US
Practice Address - Phone:602-944-4626
Practice Address - Fax:602-944-2805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZCG2109OtherRAILROAD MEDICARE
AZ25125Medicare PIN